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Dance Around the Fibula with a Twisted Plate: A Technical Note

  • Surgical Technique
  • Published:
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Abstract

Nowadays, there is a better understanding of the role of the posterior malleolar fragment in trimalleolar ankle fractures. Not fragment size, but rather fragment morphology should guide the management of the posterior malleolar fracture (PMF). Anatomical reduction and fixation of the PMF is important, as an intra-articular step-off will eventually lead to osteoarthritis. Incongruency of the incisura fibularis tibia is associated with fibular dislocation, syndesmotic insufficiency, and poor functional outcomes. Open reduction and internal fixation through a posterior approach leads to ankle joint mobility restriction (i.e., dorsal flexion deficiency) due to arthrofibrosis of the ankle joint, fibrous adhesions and secondary shortening of the flexor muscles. In this technical note, we describe a surgical technique to fixate unstable ankle fractures with a combined PMF and a high supra-syndesmotic fibular fracture through two small surgical windows using a twisted one-third tubular plate. By reducing the size of the posterolateral window, fibrous adhesions and secondary flexor muscle shortening are diminished, favoring ankle joint mobility.

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Authors and Affiliations

  1. Department of Trauma Surgery, University Hospitals Leuven, Herestraat 39, 3000, Leuven, Belgium

    Maxim Vanderstappen, Michiel Herteleer & Harm Hoekstra

  2. Department of Orthopaedics, University Hospitals Leuven, Leuven, Belgium

    Maxim Vanderstappen

  3. Department of Development and Regeneration, KU Leuven-University of Leuven, Leuven, Belgium

    Michiel Herteleer & Harm Hoekstra

Authors
  1. Maxim Vanderstappen
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  2. Michiel Herteleer
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  3. Harm Hoekstra
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Correspondence to Harm Hoekstra.

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Vanderstappen, M., Herteleer, M. & Hoekstra, H. Dance Around the Fibula with a Twisted Plate: A Technical Note. JOIO 57, 1323–1328 (2023). https://doi.org/10.1007/s43465-023-00941-3

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  • DOI: https://doi.org/10.1007/s43465-023-00941-3

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